cation that can arise after breast cancer surgery. Also referred to as cording, AWS can limit mobility, cause pain, and interfere with recovery—particularly during the early phases of healing following procedures like lymph node dissection. This condition is often linked with the development of lymphedema, making it essential for both healthcare providers and patients to recognize the signs, understand the risks, and access appropriate treatment.
In this comprehensive blog post, we’ll explore the ins and outs of axillary web syndrome, its relationship to breast cancer and lymphedema, its clinical presentation, and how patients can manage or even prevent complications through early intervention and proper care.
What Is Axillary Web Syndrome?
Axillary Web Syndrome (AWS) is a postoperative condition that typically occurs after breast cancer surgery involving axillary lymph node dissection (ALND) or sentinel lymph node biopsy (SLNB). It is characterized by the development of cord-like bands of tissue under the skin that often extend from the armpit (axilla) down the arm, sometimes reaching as far as the wrist.
These “webs” or “cords” are thought to be thrombosed or inflamed lymphatic vessels or fibrosed tissue. The presence of AWS can significantly impair shoulder and arm mobility, causing tightness, discomfort, and even visible or palpable cords beneath the skin.
How Common Is Axillary Web Syndrome?
The incidence of AWS varies across studies but is believed to occur in 20–72% of women following axillary procedures for breast cancer. According to a review in the Annals of Surgical Oncology, AWS is more common in younger patients and those who undergo extensive lymph node removal.
Despite its frequency, AWS is often underdiagnosed or mistaken for scar tissue, rotator cuff injuries, or generalized post-surgical discomfort.
Why Does Axillary Web Syndrome Happen?
Although the exact cause of AWS remains under investigation, the prevailing theory is that it stems from injury or inflammation to the lymphatic vessels during surgery. The body may respond by forming fibrotic cords in the lymphatic system, causing the telltale “web” that can limit movement and cause discomfort.
Common Risk Factors:
- Axillary lymph node dissection (more nodes removed = higher risk)
- Sentinel lymph node biopsy
- Radiation therapy
- Postoperative scarring
- Younger age (under 50)
- Low body mass index (BMI)
- Physical activity or stretching too soon after surgery
Clinical Presentation and Symptoms
The symptoms of axillary web syndrome typically present within 2 to 8 weeks post-surgery but can appear as late as several months after treatment.
Common signs and symptoms include:
- Pain or tightness in the armpit or upper arm
- Visible or palpable “cords” running from the armpit down the inner arm
- Limited shoulder or arm mobility, especially during abduction or flexion
- Pulling or snapping sensations when extending the arm
- Occasionally, cords may extend to the wrist, chest, or even flank
If left untreated, AWS can contribute to chronic pain, functional disability, and may increase the risk of developing secondary lymphedema—a condition that requires lifelong management.
Axillary Web Syndrome and Lymphedema: What’s the Connection?
There’s a growing body of evidence suggesting a clinical link between AWS and lymphedema. Since both conditions involve disruption or dysfunction of the lymphatic system, it’s not uncommon for patients with AWS to later develop lymphedema, particularly if appropriate care isn’t initiated early.
Lymphedema, characterized by chronic swelling due to lymphatic fluid buildup, can occur in the same limb affected by AWS—especially if lymphatic drainage is impaired or blocked by fibrotic tissue.
Patients experiencing AWS should be monitored closely for signs of swelling, heaviness, or changes in skin texture, which could indicate the onset of lymphedema. Proactive treatment—including manual lymphatic drainage (MLD) and compression therapy—can help reduce this risk.
Diagnosing Axillary Web Syndrome
Diagnosing AWS is largely clinical. Healthcare professionals such as physical therapists, certified lymphedema therapists, or breast surgeons will perform a physical examination to check for restricted movement, tightness, and visible cords.
Common diagnostic tools:
- Physical range-of-motion testing
- Visual and palpation assessment
- Ultrasound imaging (occasionally used to rule out DVT or vascular issues)
If you’re recovering from breast cancer surgery and notice any of the above symptoms, it’s crucial to report them to your care team promptly.
Managing and Treating Axillary Web Syndrome
Fortunately, AWS is a treatable condition, and with proper intervention, many patients experience significant improvement in symptoms over a few weeks to months.
1. Physical Therapy and Stretching
The mainstay of treatment involves gentle stretching exercises, manual soft tissue mobilization, and gradual return to normal activities. Physical therapy plays a critical role in reducing tension and breaking down fibrotic cords.
Common exercises include:
- Shoulder rolls and shrugs
- Wand exercises to improve overhead reach
- Wall climbs
- Gentle self-stretching routines
Many patients report noticeable improvement in mobility and pain within just a few therapy sessions.
2. Manual Lymphatic Drainage (MLD)
Performed by certified lymphedema therapists, MLD promotes lymph flow and helps reduce inflammation and fibrosis in affected areas. This technique can be especially helpful if AWS is accompanied by early-stage lymphedema.
Learn more about MLD and its benefits in this Lymphedema Products blog post.
3. Compression Garments
While compression is more commonly associated with lymphedema, it may also provide relief for patients with AWS, especially if swelling is present. Brands like Juzo, Sigvaris, and Jobst offer high-quality arm sleeves and wraps that support lymphatic drainage.
You can explore compression options at LymphedemaProducts.com.
4. Pain Management
Over-the-counter pain relievers such as ibuprofen or acetaminophen may be used to alleviate pain during stretching. Always consult your provider before starting new medications.
5. Patient Education and Support
Educating patients about AWS can significantly reduce anxiety and improve outcomes. Knowing that AWS is a common, treatable condition encourages early reporting and helps patients adhere to recommended therapy plans.
Prevention Strategies
While AWS cannot always be prevented, certain strategies may reduce its severity or duration:
- Avoid aggressive shoulder movement too soon after surgery
- Follow post-operative rehabilitation guidelines
- Work with a certified lymphedema therapist early in recovery
- Monitor the affected limb for tightness, swelling, or skin changes
- Stay hydrated and maintain a healthy weight
For a list of lymphedema therapists, visit the Norton School’s Therapist Locator.
Real-Life Stories
Karen’s Experience (Age 47)
After undergoing lumpectomy and ALND, Karen developed AWS within three weeks. She noticed a tight band under her arm while reaching overhead. Her physical therapist initiated daily stretches and MLD. Within one month, her cords had softened, and her range of motion returned to near-normal.
Monica’s Lymphedema Prevention (Age 63)
Monica developed AWS after SLNB and was monitored closely by a lymphedema therapist. With early intervention and daily compression sleeve use, she avoided developing lymphedema altogether.
FAQs About Axillary Web Syndrome
Conclusion
Axillary Web Syndrome is a common but manageable side effect of breast cancer treatment. Recognizing it early and starting appropriate therapy can prevent long-term disability and reduce the risk of lymphedema. For breast cancer survivors, awareness and education are key to a smoother recovery journey.
If you believe you’re experiencing AWS or are at risk, consult your healthcare provider or a Certified Lymphedema Therapist. With the right support, recovery is not only possible—it can be empowering.
References & Resources
- LymphedemaProducts.com – Compression Garments and Education
- LymphedemaProducts Blog – Massage and Compression Articles
- Norton School of Lymphatic Therapy – Therapist Referral Directory
- American Cancer Society – Breast Cancer Surgery Recovery
- BreastCancer.org – Axillary Web Syndrome Overview
